Pelvic ultrasound: A missed opportunity for earlier detection of cervical cancer?

e17538 Background: Pelvic ultrasound is an imaging modality commonly used to detect and monitor gynecologic malignancy and has broad potential for use in low-resource settings due to its low cost and portability. In cases of cervical cancer, pelvic ultrasound has been shown to reliably detect tumor size, parametrial involvement, and increased vascularity. 1 The aim of this study was to assess the use of ultrasound among a cohort of cervical cancer patients and compare the findings to other imaging modalities. Methods: A retrospective cohort study was performed using a dual-institution database of patients who received treatment for cervical cancer at four New York City hospitals (one public and three private) from 2010-2024. Demographics, timing of diagnostic imaging, and results of diagnostic imaging were extracted from charts. Diagnostic reports were analyzed qualitatively with thematic analysis. 2 Results: Of the 2,009 patients in the database, 115 had comprehensive data on treatment and imaging available and 26 patients were identified as having had pelvic ultrasounds. Ultrasounds were ordered for the indications of vaginal bleeding (n=19, 73%), prior diagnosis or concern for malignancy (n=6, 23%), pelvic or abdominal pain (n=5, 19%), and thickened endometrium incidentally noted on prior CT scan (n=1, 4%). Of the 26 ultrasounds, 8% described the cervix as normal (n=2), 50% described the cervix as abnormal (n=13), and 38% did not comment on the cervix at all (n=10). Abnormal findings included a cervical mass (n=8, 62%), increased vascularity (n=6, 46%), or hypoechoic areas (n=3, 23%). Ultrasounds obtained prior to a diagnosis of cervical cancer were obtained on average 16.1 days prior to diagnosis, 2.1 days prior to first CT scan, 32.1 days prior to first MRI, and 23.5 days prior to first PET CT. Overall, 11 patients had a pelvic ultrasound in which the cervix was noted to be normal or not commented on and later had a CT, MRI, or PET scan showing significant abnormality, including masses measuring 2.1 to 6.4 cm in size. Conclusions: This study demonstrates that patients with cervical cancer are often initially evaluated with ultrasound, but the cervix is often not evaluated and significant abnormalities are missed, potentially leading to delays in diagnosis and treatment. Further exploration of the role of ultrasound imaging in the early detection of cervical cancer, potentially through quality improvement initiatives in conjunction with radiology colleagues could offer benefit to patients, especially in low-resource settings. 1. Hsiao YH, Yang SF, Chen YH, Chen TH, Tsai HD, Chou MC, Chou PH. Updated applications of Ultrasound in Uterine Cervical Cancer. J Cancer. 2021 Feb 22;12(8):2181-2189. doi: 10.7150/jca.49479. PMID: 33758596; PMCID: PMC7974902. 2. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology . 2006;3(2):77-101. doi:10.1191/1478088706qp063oa.